{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T02:38:13Z","timestamp":1791859093783,"version":"4.3.4"},"posted":{"date-parts":[[2026,6,25]]},"group-title":"Geriatric Medicine","reference-count":33,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"award":["349335 and 349336"],"award-info":[{"award-number":["349335 and 349336"]}],"id":[{"id":"https:\/\/ror.org\/05k73zm37","id-type":"ROR","asserted-by":"publisher"}]},{"id":[{"id":"https:\/\/ror.org\/02w907m39","id-type":"ROR","asserted-by":"publisher"}]},{"id":[{"id":"https:\/\/ror.org\/00ckakm23","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Samfundet Folkhalsan"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,6,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Existing electronic frailty indices (eFI) are typically based on structured data and designed for older adults. We developed an eFI that integrates structured and unstructured electronic health records (EHRs) across adulthood and assessed its longitudinal trajectories and associations with adverse outcomes.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We used longitudinal EHR data from 193629 individuals aged 35\u2013103 in the Wellbeing Services County of Central Finland (2010\u20132023) and constructed a 53-item eFI including diagnosis codes, laboratory tests and items extracted from free-text clinical notes using deep-learning-based natural language processing. Associations with all-cause mortality, severe infections, fractures, and healthcare utilization were assessed using Cox and count models. Predictive performance was compared with Hospital Frailty Risk Score (HFRS) and Charlson Comorbidity Index (CCI).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Findings<\/jats:title>\n                  <jats:p>eFI trajectories accelerated notably from age 65 onwards. Using the eFI as a categorical variable, severe frailty was associated with higher risks of mortality (hazard ratio [HR] 7\u00b731, 95% confidence interval [CI] 6\u00b783\u20137\u00b783), severe infections (HR 9\u00b722, 95%CI 8\u00b752\u2013 9\u00b798), fractures (HR 2\u00b775, 95%CI 2\u00b752\u20133\u00b701) and increased healthcare utilization (odds ratio [OR] 3\u00b715, 95%CI 2\u00b796\u20133\u00b735) compared with non-frail. The risks were relatively greater in younger age groups and persisted when using the continuous eFI restricted to non-frail individuals. Across all outcomes, the eFI showed greater model discrimination than HFRS and CCI.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Interpretation<\/jats:title>\n                  <jats:p>An eFI using structured and unstructured EHR data improves risk stratification even in younger adults and at very low levels of frailty.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Funding<\/jats:title>\n                  <jats:p>Research Council of Finland, Instrumentarium Science Foundation, Sigrid Jus\u00e9lius Foundation and Samfundet Folkh\u00e4lsan.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.06.23.26356323","type":"posted-content","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:13Z","timestamp":1782432013000},"source":"Crossref","is-referenced-by-count":1,"title":["A next-generation electronic frailty index leveraging deep learning on unstructured health records extends risk prediction across the full frailty spectrum"],"prefix":"10.64898","author":[{"given":"Esha","family":"Khan","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Ottaviani","sequence":"additional","affiliation":[{"name":"Geriatric Clinic, Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juho","family":"Kaijansinkko","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus J","family":"Haapanen","sequence":"additional","affiliation":[{"name":"Research Unit of Clinical Medicine, Faculty of Medicine, University of Oulu, Oulu, Finland"},{"name":"Folkh\u00e4lsan Research Center, Helsinki, Finland"},{"name":"Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Tirkkonen","sequence":"additional","affiliation":[{"name":"Folkh\u00e4lsan Research Center, Helsinki, Finland"},{"name":"Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyv\u00e4skyl\u00e4, Jyv\u00e4skyl\u00e4, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan K","family":"L Mak","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland"},{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Pajulammi","sequence":"additional","affiliation":[{"name":"Department of Geriatric Medicine, Central Finland Hospital Nova, Wellbeing Services County of Central Finland, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikaela B","family":"von Bonsdorff","sequence":"additional","affiliation":[{"name":"Folkh\u00e4lsan Research Center, Helsinki, Finland"},{"name":"Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyv\u00e4skyl\u00e4, Jyv\u00e4skyl\u00e4, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jake","family":"Lin","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland"},{"name":"Faculty of Medicine, University of Helsinki, Helsinki, 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